WHO – New Guidelines on Sweeteners Safety

Posted On: 17th August 2023

A recent report by the World Health Organization (WHO) has advised against the use of ‘non-nutritive sweeteners’ (NNS) for weight loss. The report has caused a lot of confusion because its “conditional” advice is based upon no new evidence and the evidence it is based on is “low certainty”. Indeed, all of the best recent reviews have come to the opposite conclusions. As such, we would advise that the public can be confident that this report should not change the way people think about sweeteners. The weight of evidence strongly indicates that they are safe and when used to replace sugar, they are effective for weight loss and can have beneficial effects upon the diseases that accompany being overweight.

A recent report by the World Health Organization (WHO) has advised against the use of ‘non-nutritive sweeteners’ (NNS) for weight loss. The report essentially concludes that sweeteners are not useful for weight loss or preventing disease and that there may be “potential undesirable effects from long-term use”^1.

As a trade organisation, with several members who are scientists and experts in the field of nutrition, and therefore intimately familiar with the safety and effectiveness data on sweeteners, we were perplexed at the WHO’s recommendations.

The response was similar from colleagues of TDMR members and various other institutions and academics. The British Nutrition Foundation responded to say, since sweeteners “have been rigorously tested for safety, it seems sensible to continue to make use of all the tools at our disposal to improve people’s diets” …and… “randomised controlled trials (RCTs) … have found that higher non-sugar sweetener (NSS) consumption by adults led to lower body weight and BMI”^2.

Academics from the University of California have also responded, “We found the WHO’s advisory surprising based on the study’s equivocal results” and described the WHO’s conclusions as “puzzling”^3.

The official advice of the NHS on sweeteners is, “All approved sweeteners are considered a safe and acceptable alternative to using sugar” and, addressing some of the most provocative claims about sweeteners, Cancer Research UK has said “sweeteners do not cause cancer”⁴.

Additionally, the WHO report itself admits their evidence was “low certainty” and their recommendations “conditional”^1.

TDMR’s Science Committee have reviewed whether there is any new evidence to support WHO’s results.

Below are the conclusions of the most-recent, largest, and best review studies on the topic:

• 2022: “This review has evaluated the scientific literature in-depth and concludes that NNSs are safe to use within an acceptable daily intake (ADI). Non-nutritive sweeteners are beneficial for their intended use, including weight management and diabetes control”⁵
• 2022: “Overall, the balance of evidence indicates that use of LES [low energy sweeteners] in place of sugar, in children and adults, leads to reduced EI [energy intake] and BW [body weight]”⁶
• 2021: “The evidence from human intervention studies supports the use of LCS [low calorie sweeteners] in weight management”⁷
• 2018: “LNCS [sweeteners] are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority”⁸
• 2016: “there is no evidence found to question the safety of the authorized intensive sweeteners”⁹

 

No other large health or regulatory organisations have made similar new recommendations on sweeteners and many large government and industry groups, and other professional organisations have not responded to this WHO report.

The report paints all the most common sweeteners with the same brush, despite each sweetener having a distinct chemical structure and being metabolised differently by the body. This is not an appropriate or valid approach.  It would make more sense if sweeteners were evaluated separately, each as a unique molecule.

A further point of note is the WHO’s suggested alternative to using sweeteners is to find other ways to reduce sugar. The consumption of fruit or unsweetened food and drinks is encouraged in the report. A long-standing recommendation which is of questionable efficacy in weight loss.

 

 

Mark Gilbert and Kelly Johnston, members, Science Committee, TDMR Europe

Anthony Leeds, chair, TDMR Europe

14^th August 2023

 

References:

1. https://news.un.org/en/story/2023/05/1136667
2. Statement on WHO non-sugar sweeteners guideline. British Nutrition Foundation, 16^th May, 2023 – https://www.nutrition.org.uk/news/2023/statement-on-who-non-sugar-sweeteners-guideline/
3. WHO’s recommendation against the use of artificial sweeteners for weight loss leaves many questions unanswered. USC Dornsife. Lindsey Schier and Scott Kanoski June 08, 2023. https://theconversation.com/whos-recommendation-against-the-use-of-artificial-sweeteners-for-weight-loss-leaves-many-questions-unanswered-206175
4. The Truth About Sweeteners. NHS, Live Well. 2023 Feb. https://www.nhs.uk/live-well/eat-well/food-types/are-sweeteners-safe/
5. Tiwaskar M, Mohan V. Clearing the Myths around non-nutritive/noncaloric Sweeteners: An Efficacy and Safety Evaluation. J Assoc Physicians India. 2022 Jul;70(7):11-12.
6. Wilk K, et al. The Effect of Artificial Sweeteners Use on Sweet Taste Perception and Weight Loss Efficacy: A Review. Nutrients. 2022 Mar 16;14(6):1261.
7. Rogers PJ, Appleton KM. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes (Lond). 2021 Mar;45(3):464-478.
8. Serra-Majem L, et al. Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages. Nutrients. 2018 Jun 25;10(7):818.
9. Lugasi A. Az intenzív édesítőszerek biztonságossága [Safety of intensive sweeteners]. Orv Hetil. 2016 Apr;157 Suppl 1:14-28.